2017-09-26T23:18:12Zhttp://www.ijhpm.com/?_action=export&rf=summon&issue=6152014-12-01International Journal of Health Policy and ManagementIJHPM201437Have Health Human Resources Become More Equal Between Rural and Urban Areas after the New Reform?QianYangHengjinDongThe lack of health human resources is a global issue. China also faces the same issue, in addition to the equity of human resources allocation. With the launch of new healthcare reform of China in 2009, have the issues been improved? Relevant data from China Health Statistical Yearbook and a qualitative study show that the unequal allocation of health human resources is getting worse than before.EqualityChinaHealth Human ResourcesRural AreaUrban Area20141201359360http://www.ijhpm.com/article_2928_1929e17220efa360d096d2ef9805c484.pdf2014-12-01International Journal of Health Policy and ManagementIJHPM201437On Health Policy and Management (HPAM): Mind the Theory-Policy-Practice GapDavidChinitzVictorRodwinWe argue that the field of Health Policy and Management (HPAM) ought to confront the gap between theory, policy, and practice. Although there are perennial efforts to reform healthcare systems, the conceptual barriers are considerable and reflect the theory-policy-practice gap. We highlight four dimensions of the gap: 1) the dominance of microeconomic thinking in health policy analysis and design; 2) the lack of learning from management theory and comparative case studies; 3) the separation of HPAM from the rank and file of healthcare; and 4) the failure to expose medical students to issues of HPAM. We conclude with suggestions for rethinking the field of HPAM by embracing broader perspectives, e.g. ethics, urban health, systems analysis and cross-national analyses of healthcare systems.Health PolicyHealth Management TheoryMedical Education20141201361363http://www.ijhpm.com/article_2919_39cc81079e4f6a09446da27799778bd2.pdf2014-12-01International Journal of Health Policy and ManagementIJHPM201437Essential Drugs Production in Brazil, Russia, India, China and South Africa (BRICS): Opportunities and ChallengesZoheirEzzianeThe objective of this work is to elucidate various essential drugs in the Brazil, Russia, India, China and South Africa (BRICS) countries. It discusses the opportunities and challenges of the existing biotech infrastructure and the production of drugs and vaccines in member states of the BRICS. This research is based on a systematic literature review between the years 2000 and 2014 of documents retrieved from the databases Embase, PubMed/Medline, Global Health, and Google Scholar, and the websites of relevant international organizations, research institutions and philanthropic organizations. Findings vary from one member state to another. These include useful comparison between the BRICS countries in terms of pharmaceuticals expenditure versus total health expenditure, local manufacturing of drugs/vaccines using technology and know-how transferred from developed countries, and biotech entrepreneurial collaborations under the umbrella of the BRICS region. This study concludes by providing recommendations to support more of inter collaborations among the BRICS countries as well as between BRICS and many developing countries to shrink drug production costs. In addition, this collaboration would also culminate in reaching out to poor countries that are not able to provide their communities and patients with cost-effective essential medicines.Brazil, Russia, India, China, South Africa (BRICS)Global HealthInfluenceNewly Emerging Economies20141201365370http://www.ijhpm.com/article_2917_93957259544ea86037d24ed55bc6d135.pdf2014-12-01International Journal of Health Policy and ManagementIJHPM201437Morality and Markets in the NHSBarnabasGilbertEmmaClarkeLaurenceLeaverSince its establishment in 1948, the history of the National Health Service (NHS) has been characterized by organisational turbulence and system reform. At the same time, progress in science, medicine and technology throughout the western world have revolutionized the delivery of healthcare. The NHS has become a much loved, if much critiqued, national treasure. It is against this backdrop that the role of this state-funded health service has been brought into moral question. Certainly, the challenges facing healthcare policy-makers are numerous and complex, but in the wake of the Health and Social Care Act (2012), no issue is more divisive than that of market-based reform. Here we explore the turbulent history of the NHS, from its foundation to the birth of the healthcare marketplace. We explore arguments for and against the healthcare market and resolve that, amid an evolving economic and moral framework, the NHS must ensure that its original tenets of equity and autonomy remain at its core. We propose a values-explicit, systems-based approach to renew focus on both the processes and the outcomes of care.National Health Service (NHS)MarketplaceMorality20141201371376http://www.ijhpm.com/article_2921_bf419e7bacdf439fade685014bda81f7.pdf2014-12-01International Journal of Health Policy and ManagementIJHPM201437Factors Affecting Family Physicians’ Drug Prescribing: A Cross-Sectional Study in Khuzestan, IranMohammadArabAminTorabi PourAbbasRahimifrooshaniArashRashidianNayebFadaiRoohollahAskariBackground Rational prescription is a considerable issue which must be paid more attention to assess the behavior of prescribers. The aim of this study was to examine factors affecting family physicians’ drug prescribing. Methods We carried out a retrospective cross-sectional study in Khuzestan province, Iran in 2011. Nine hundred eighty-six prescriptions of 421 family physicians (including 324 urban and 97 rural family physicians) were selected randomly. A multivariate Poisson regression was used to investigate potential determinants of the number of prescribed drug per patient. Results The mean of medication per patient was 2.6 ± 1.2 items. In the majority (91.9%) of visits a drugs was prescribed. The most frequent dosage forms were tablets, syrups and injection in 30.1%, 26.9%, and 18.7% of cases respectively. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and antibiotics were 29.7% and 17.1% of prescribed drugs respectively. The tablets were the most frequent dosage forms (38.6% of cases) in adult’s patients and syrups were the most frequent dosage forms (49% of cases) in less than 18 years old. Paracetamols were popular form of NSAIDs in two patients groups. The most common prescribed medications were oral form. Conclusion In Khuzestan, the mean of medication per patient was fewer than national average. Approximately, pattern of prescribed drug by family physicians (including dosage form and type of drugs) was similar to other provinces of Iran.Drug PrescribingFamily PhysicianPrimary CareKhuzestan20141201377381http://www.ijhpm.com/article_2902_848c9b74a26775dec8554fe781049540.pdf2014-12-01International Journal of Health Policy and ManagementIJHPM201437Cholecystectomy and Diagnosis-Related Groups (DRGs): Patient Classification and Hospital Reimbursement in 11 European CountriesGerliPaat-AhiAinAaviksooMariaŚwiderekBackground As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their Diagnosis-Related Groups (DRG) systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. Methods National or regional databases were used to identify hospital cases with a procedure of cholecystectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardised case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained and compared to an index case. Results European DRG systems vary widely: they classify cholecystectomy patients according to different sets of variables into diverging numbers of DRGs (between two DRGs in Austria and Poland to nine DRGs in England). The most complex DRG is valued at four times more resource intensive than the index case in Ireland but only 1.3 times more resource intensive than the index case in Austria. Conclusion Large variations in the classification of cholecystectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons, hospital managers and national DRG authorities should consider how other countries’ DRG systems classify cholecystectomy patients in order to optimize their DRG systems and to ensure fair and appropriate reimbursement.CholecystectomyDiagnosis-Related Groups (DRGs)EuropeEconomicsHospital20141201383391http://www.ijhpm.com/article_2920_1adfaf40fd69e21d1a9feeba435f17a5.pdf2014-12-01International Journal of Health Policy and ManagementIJHPM201437‘Only Systems Thinking Can Improve Family Planning Program in Pakistan’: A Descriptive Qualitative StudySairaZafarBabarShaikhBackground Family Planning (FP) program in Pakistan has been struggling to achieve the desired indicators. Despite a well-timed initiation of the program in late 50s, fertility decline has been sparingly slow. As a result, rapid population growth is impeding economic development in the country. A high population growth rate, the current fertility rate, a stagnant contraceptive prevalence rate and high unmet need remain challenging targets for population policies and FP programs. To accelerate the pace of FP programs and targets concerned, it is imperative to develop and adopt a holistic approach and strategy for plugging the gaps in various components of the health system: service delivery, information systems, drugs-supplies, technology and logistics, Human Resources (HRs), financing, and governance. Hence, World Health Organization (WHO) health systems building blocks present a practical framework for overall health system strengthening. Methods This descriptive qualitative study, through 23 in-depth interviews, explored the factors related to the health system, and those responsible for a disappointing FP program in Pakistan. Provincial representatives from Population Welfare and Health departments, donor agencies and non-governmental organizations involved with FP programs were included in the study to document the perspective of all stakeholders. Content analysis was done manually to generate nodes, sub-nodes and themes. Results Performance of FP programs is not satisfactory as shown by the indicators, and these programs have not been able to deliver the desired outcomes. Interviewees agreed that inadequate prioritization given to the FP program by successive governments has led to this situation. There are issues with all health system areas, including governance, strategies, funding, financial management, service delivery systems, HRs, technology and logistic systems, and Management Information System (MIS); these have encumbered the pace of success of the program. All stakeholders need to join hands to complement efforts and to capitalize on each other’s strengths, plugging the gaps in all the components of FP programming. Conclusion All WHO health system building blocks are interrelated and need to be strengthened, if the demographic targets are to be achieved. With this approach, the health system shall be capable of delivering fair and responsive FP services.Systems ThinkingStakeholder AnalysisFamily Planning (FP)Developing CountriesPakistan20141201393398http://www.ijhpm.com/article_2922_0c50c9470275bdf35d19b8874bf3df19.pdf2014-12-01International Journal of Health Policy and ManagementIJHPM201437Constraints to Applying Systems Thinking Concepts in Health Systems: A Regional Perspective from Surveying Stakeholders in Eastern Mediterranean CountriesFadiEl-JardaliTaghreedAdamNourAtayaDianaJamalMahaJaafarBackground Systems Thinking (ST) has recently been promoted as an important approach to health systems strengthening. However, ST is not common practice, particularly in Low- and Middle-Income Countries (LMICs). This paper seeks to explore the barriers that may hinder its application in the Eastern Mediterranean Region (EMR) and possible strategies to mitigate them. Methods A survey consisting of open-ended questions was conducted with a purposive sample of health policymakers such as senior officials from the Ministry of Health (MoH), researchers, and other stakeholders such as civil society groups and professional associations from ten countries in the region. A total of 62 respondents participated in the study. Thematic analysis was conducted. Results There was strong recognition of the relevance and usefulness of ST to health systems policy-making and research, although misconceptions about what ST means were also identified. Experience with applying ST was very limited. Approaches to designing health policies in the EMR were perceived as reactive and fragmented (66%). Commonly perceived constraints to application of ST were: a perceived notion of its costliness combined with lack of the necessary funding to operationalize it (53%), competing political interests and lack of government accountability (50%), lack of awareness about relevance and value (47%), limited capacity to apply it (45%), and difficulty in coordinating and managing stakeholders (39%). Conclusion While several strategies have been proposed to mitigate most of these constraints, they emphasized the importance of political endorsement and adoption of ST at the leadership level, together with building the necessary capacity to apply it and apply the learning in research and practice.Systems Thinking (ST)Health SystemsEastern Mediterranean Region20141201399407http://www.ijhpm.com/article_2924_1c7862be2a2460f19ec87df5e9c49db3.pdf2014-12-01International Journal of Health Policy and ManagementIJHPM201437On the Cost of Shame; Comment on “Nudging by Shaming, Shaming by Nudging”EmmaTieffenbachIn his editorial, Nir Eyal argues that a nudge can exploit our propensity to feel shame in order to steer us toward certain choices. We object that shame is a cost and therefore cannot figure in the apparatus of a nudge.NudgeHealthCostShameShaming20141201409411http://www.ijhpm.com/article_2923_c5434349d7d9eedf2a8674300923a7e2.pdf2014-12-01International Journal of Health Policy and ManagementIJHPM201437Localization of Determinants of Fertility through Measurement Adaptations in Developing-Country Settings: The Case of Iran; Comment on “Analysis of Economic Determinants of Fertility in Iran: A Multilevel Approach”AmirErfaniStudies investigating fertility decline in developing countries often adopt measures of determinants of fertility behavior developed based on observations from developed countries, without adapting them to the realities of the study setting. As a result, their findings are usually invalid, anomalous or statistically non-significant. This commentary draws on the research article by Moeeni and colleagues, as an exemplary work which has not adapted measures of two key economic determinants of fertility behavior, namely gender inequality and opportunity costs of childbearing, to the realities of Iran’s economy. Measurement adaptations that can improve the study are discussed.LocalizationFertility BehaviorGender EqualityPopulation PolicyMeasurementIran20141201413415http://www.ijhpm.com/article_2926_9ed3515e5981cba70d6cbf5821175d81.pdf2014-12-01International Journal of Health Policy and ManagementIJHPM201437Preventing the Emergence of Ebola Disease in Unaffected Countries: Necessity of PreparednessSaurabhShrivastavaPrateekShrivastavaJegadeeshRamasamyEbola DiseasePreparednessPublic Health Emergency20141201417418http://www.ijhpm.com/article_2914_7d519d2a3efdce4be2ee502c65ac21b2.pdf